Impact of glucocorticoids on insulin resistance in the critically ill

@article{Pretty2011ImpactOG,
  title={Impact of glucocorticoids on insulin resistance in the critically ill},
  author={Christopher G. Pretty and J. Geoffrey Chase and Jessica Lin and Geoffrey M. Shaw and Aaron J. Le Compte and Normy N. Razak and Jacquelyn D. Parente},
  journal={Computer methods and programs in biomedicine},
  year={2011},
  volume={102 2},
  pages={
          172-80
        }
}
Glucocorticoids (GCs) have been shown to reduce insulin sensitivity in healthy individuals. Widely used in critical care to treat a variety of inflammatory and allergic disorders, they may inadvertently exacerbate stress-hyperglycaemia. This research uses model-based methods to quantify the reduction in insulin sensitivity from GCs in critically ill patients, and thus their impact on glycaemic control. A model-based measure of insulin sensitivity (S(I)) was used to quantify changes between two… CONTINUE READING
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Key Quantitative Results

  • A 31% reduction in whole-cohort median insulin sensitivity was seen between the control cohort and patients receiving glucocorticoids with a median dose equivalent to 200mg/d of hydrocortisone per patient. Comparing percentile patients as a surrogate for matched patients, reductions in median insulin sensitivity of 20%, 25%, and 21% were observed for the 25th-, 50th- and 75th-percentile patients, respectively.
  • Virtual trial simulation showed that reductions in insulin sensitivity of 20-30% associated with glucocorticoid treatment in the ICU have limited impact on glycaemic control levels within the context of the SPRINT protocol.
  • A 31% reduction in whole-cohort median insulin sensitivity was seen between the control cohort and patients receiving glucocorticoids with a median dose equivalent to 200mg/day of hydrocortisone per patient.
  • Virtual patient simulations show that the SPRINT protocol can manage these changes in SI by modulating the insulin and nutrition inputs by up to 20%, while maintaining tight glycaemic control.

Citations

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The impact of metoprolol on insulin sensitivity in the ICU MCBMS 2009

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Relationship Between Glucocorticoids and Insulin Resistance in Healthy Individuals

  • Medical science monitor : international medical journal of experimental and clinical research
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